Start saving now! Fill out the registration form below and an account manager will get back to you soon to complete the process and get you ordering today!We only ship to US & Puerto RicoPlease enable JavaScript in your browser to complete this form.Name *Business Name *Email *Phone Number *Address *City *StateState/Territory*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming---Puerto RicoZip Code *What type of business are you?Retail PharmacyDr./Physician OfficeClinicHospitalLTC FacilityWholesalerOther for OTC OnlyWho is your primary vendor?AmerisourceBergenCardinalMcKessonOtherWhat products are you focused on?BrandsGenericsOTCsTopicalsDiabetic SuppliesOtherSelect all that applyHow did you hear about River City?Phone CallWord of MouthSearch EngineOnline AdTradeshowRxInsiderOtherHave you spoken to a River City Sales Rep? If so, what was their name?(Optional)Do you hold any State or Federal Licenses? *Please SelectYesNoA valid license is required to order from Masters Pharmaceutical.If you are a new pharmacy awaiting licensing, please submit the form to speak to a representative about your situation.Please select all that apply:DEA# STATE#HIN#DEA#DEA#Format: AA-9999999 (dash optional)DEA # - Providing at later date I will provide at a later dateState#State#Format: Alphanumeric (First 5 required then up to 18 characters)State # - Providing at later date I will provide at a later dateHIN#HIN#Format: Alphanumeric (up to 11 characters)HIN # - Providing at later date I will provide at a later dateAdditional InfoNameSend Registration
